Update on the Role of SLIT in Tolerance Induction to Allergens: Safety and Efficacy

Sublingual immunotherapy (SLIT) is under observation since more than 25 years, as a viable alternative to the traditional standard route of administration. So far, there are about 70 RDBPC trials confirming its clinical efficacy (in most trials >20% over placebo) in both adults and children. The largest trials have been conducted with grass allergens, but also trials with ragweed and mites are available in literature. The clinical efficacy of SLIT was confirmed by several meta-analyses, although the heterogeneity of the studies (doses, patients’ selection, outcomes) limit their robustness.

The safety of SLIT has been well ascertained, since only 6 cases of anaphylaxis (and no fatal event) has been reported so far. Due to the safety profile, SLIT has been proposed as a possible approach to food allergy, venom allergy and atopic dermatitis. Principal unmet needs remain the standardization of extracts, the design of clinical trials and the methodological aspects.